There may be many reasons, which may make the joints in our body painful. Most common causes of joint pain are inflammatory joint disease, joint injury and degenerative joint disease. Degenerative joint disease is caused by normal wear and tear of the joint or minor injury triggering joint degeneration. In this article we are going to go in depth about a medical condition, which may be rare, but can result in acute pain in the joints. This condition is called Palindromic Rheumatism. Another name for Palindromic Rheumatism is Palindromic Arthritis. Palindromic rheumatism is also thought to be pre-rheumatoid arthritis condition.1, 2

What is Palindromic Rheumatism or Palindromic Arthritis?

Palindromic Rheumatism or Palindromic Arthritis is a condition in which there are sudden and quickly progressing attacks of arthritis resulting in excruciating pain, redness, swelling, of one or more joints in the body. The frequency, intensity, and duration of the attacks of Palindromic Rheumatism or Palindromic Arthritis can vary quite a bit. Palindromic Rheumatism is a type of inflammatory arthritis. As stated, these attacks may start in one joint and quickly spread to other joints of the body. In between these attacks, the joints are normally functioning.

Causes of Palindromic Rheumatism or Palindromic Arthritis

As Palindromic Rheumatism or Palindromic Arthritis is a rare condition not much research has been done in this sphere; however, studies show that the inflammatory cells migrate into the lining of joint causing what can be termed as classic features of joint inflammation namely pain, redness, swelling etc. What triggers these attacks related to Palindromic Rheumatism or Palindromic Arthritis is still unknown, although some studies show a genetic link but it is not generally the case. There may be other factors provoking these attacks like infection, trauma, etc. Unlike other rheumatic disorders, Palindromic Rheumatism or Palindromic Arthritis affects both males and females equally and is independent of the age meaning they can occur at any age.

Symptoms of Palindromic Rheumatism or Palindromic Arthritis

Attacks of Palindromic Rheumatism or Palindromic Arthritis usually begin in one joint and rapidly spread to other joints making the joints painful, swollen, and stiff.3 Other symptoms of Palindromic Rheumatism or Palindromic Arthritis are

Tenderness at the joints is one of the symptoms of Palindromic Rheumatism or Palindromic Arthritis

Redness of skin over the joint

Pain and swelling of the tendons and the region surrounding the joint is also one of the symptoms of Palindromic Rheumatism or Palindromic Arthritis

Feeling of general malaise

Fatigue

Slight fever.

In Palindromic Rheumatism or Palindromic Arthritis, joints that are involved at the start of the attack improve after some time as the attack migrates from one joint to the other getting progressively worse with the attack dissipating completely and the joints returning back to their normal function. One thing is certain that Palindromic Rheumatism or Palindromic Arthritis does not affect or damage the joints. The frequency of the attacks of Palindromic Rheumatism or Palindromic Arthritis vary from person to person with some people getting attacks rarely to the tune of may be once a year and some people getting the attacks as frequently as may be once a week. Similarly, the duration of the attacks of Palindromic Rheumatism also vary in which they may last for some hours for some people and for several days for some individuals. What differentiates Palindromic Rheumatism or Palindromic Arthritis from other forms of inflammatory conditions is the fact that the pattern of the attacks is always similar and in between attacks there are absolutely no symptoms to speak of.

Diagnosis of Palindromic Rheumatism or Palindromic Arthritis

Since Palindromic Rheumatism or Palindromic Arthritis is an extremely rare condition, hence it can be confused with other inflammatory conditions like rheumatoid arthritis. Hence evaluation by a specialized rheumatologist is essential for a confirmatory diagnosis of Palindromic Rheumatism or Palindromic Arthritis. There is no one particular test which can confirm Palindromic Rheumatism since it is a rare condition and a diagnosis is made by virtue of the symptoms experienced by the individual and ruling out other inflammatory conditions like rheumatoid arthritis or gout. The best way to get a confirmatory diagnosis of Palindromic Rheumatism or Palindromic Arthritis is to get examined during an attack as the symptoms dissipate after the attack.

Blood draws to look at the ESR and CRP can be done as they may show increased levels in cases of Palindromic Rheumatism or Palindromic Arthritis.

Treatment for Palindromic Rheumatism or Palindromic Arthritis

The following treatments can be done Palindromic Rheumatism or Palindromic Arthritis:

Medications to Treat Palindromic Rheumatism or Palindromic Arthritis

NSAIDs for Palindromic Rheumatism or Palindromic Arthritis

NSAIDs help a great way in reducing inflammation and pain and can be quite helpful during attacks of Palindromic Rheumatism or Palindromic Arthritis.

The only drawback with NSAIDs is that the relief is not long lasting and the individual suffering from Palindromic Rheumatism or Palindromic Arthritis will have to take the NSAIDs medication regularly till the attacks last.

DMARDs for Palindromic Rheumatism or Palindromic Arthritis

DMARDs are medications, which gets into the cause of the inflammation and in case of Palindromic Rheumatism or Palindromic Arthritis they help in reducing the frequency and severity of the attacks.

Some of DMARDs are hydroxychloroquine and sulfasalazine.

While taking these medications the individual suffering from Palindromic Rheumatism or Palindromic Arthritis needs to have close monitoring with regular blood draws to look at kidney and liver functions.

Steroid injections can be recommended for patients suffering from Palindromic Rheumatism or Palindromic Arthritis if the joints are extremely painful and not responding to NSAIDs in order to calm down the inflammation and reduce pain.

Prognosis and Outlook of Palindromic Rheumatism or Palindromic Arthritis

It is virtually impossible to predict the outlook of Palindromic Rheumatism or Palindromic Arthritis because of its variableness but still Palindromic Rheumatism or Palindromic Arthritis completely dissipates in about 15% of people, about 50% have attacks occasionally, and around 40% have chronic problems. Some people suffering from Palindromic Rheumatism or Palindromic Arthritis may go on to develop rheumatoid arthritis and then the joints may start to get damaged.

References

1. Palindromic rheumatism: a pre-rheumatoid arthritis state?

Katz SJ, Russell AS.

J Rheumatol. 2012 Oct;39(10):1912-3. doi: 10.3899/jrheum.120995.

2. Palindromic rheumatism: a descriptive report of seven cases from North Dakota and a short review of literature.